Echolalia

What is echolalia?

Echolalia (echophrasia) is the action of repeating what someone else says. The repetition could be words or phrases. This behavior is automatic and non-voluntary (you don’t mean to do it). It’s common among toddlers who are learning how to talk and people diagnosed with autism spectrum disorder.

Are there different types of echolalia?

A healthcare provider may categorize echolalia in the following ways:

• Immediate or delayed: If the repeated word or phrase happens right after someone else says it, it’s immediate. If time passes between the moment someone says the word or phrase and the action of repeating it, it’s delayed.
• Communicative or semi-communicative: It’s communicative if the word or phrase repeated has meaning within a conversation (it answers a question) or the reason for repetition isn’t clear (semi-communicative).
• Unmitigated or mitigated: The repetition matches exactly how another person said it (unmitigated) or there are changes to the intonation, which is the tone or pitch of speech (mitigated).
• Ambient or echoing approval: Ambient is repeating words from the surrounding environment (like from television, for example). Echoing approval is repeating words in a positive or negative tone in response to a question asked to either themselves or someone else.

What’s an example of echolalia?

When a child is learning how to speak, they may repeat words in the question instead of giving you an answer like “yes” or “no.” For example, you may offer a child a toy and ask them, “Would you like this toy?” A child might respond with, “Toy, toy,” instead of “Yes.” This type of echolalia is immediate.

What are the most common causes of echolalia?

We aren’t exactly sure why echolalia happens. Repeating speech is a normal part of language development. It usually improves or goes away by age 3.

Some medical conditions can cause echolalia. A sign that an underlying condition is causing echolalia is if it happens after age 3. The most common condition that causes this symptom is autism spectrum disorder (ASD). Approximately 75% of people diagnosed with ASD experience echolalia.

Other common conditions that cause echolalia include:

• Attention-deficit/hyperactivity disorder (ADHD).
• Aphasia.
• Head injury.
• Dementia.
• Developmental delay.
• Encephalitis.
• Tourette syndrome.
• Schizophrenia.
• Stress and anxiety.
• Stroke.

This isn’t an exhaustive list of all conditions that cause echolalia. A healthcare provider will complete a physical exam and testing before making an official diagnosis of what causes your symptoms.

Researchers believe this symptom happens due to frontal lobe dysfunction (the area of your brain that manages your thoughts, movements and memory) that relates to:

• Dopamine dysregulation theory: Too much or too little dopamine (a brain chemical) can affect the way your brain tells your body how to communicate.
• Broken mirror neuron theory: Specialized neurons (nerve cells in your brain) aren’t working as expected.
• Wealth of stimulus hypothesis: There’s a disconnect between what you learn and how your body responds to it (speech).

How is echolalia treated?

Treatment for echolalia depends on what causes it. The goals of treatment are to:

• Identify the reason for repetition.
• Understand the meaning of repetition.
• Respond in a helpful way to encourage clear communication.

Treatment may include:

• Therapy (speech therapy, music therapy, cognitive behavioral therapy).
• Medications (pharmacotherapy).

Who treats echolalia?

Your care team for echolalia may include:

• Neurodevelopmental specialists.
• Therapists.
• Speech-language pathologists.
• Psychologists.
• Special educators.

In addition, family and friends can help support a person who experiences echolalia, especially children. It’s important for people to practice the skills they learn in therapy at home to reinforce new behaviors.

How do I communicate with someone who experiences echolalia?

It can be challenging to understand what someone is saying to you when they aren’t able to communicate in a way you recognize. To help you know what someone is saying, follow these tips:

• Observe the person’s behavior and body language (pointing to something they want, holding something, etc.).
• Listen to the words or phrases they’re repeating and the tone (does it sound positive or negative or does their voice get higher at the end of the phrase like a question).
• Wait for your cue to respond and don’t interrupt the person who’s talking.

After you’ve interpreted or taken time to understand what someone is saying, you can respond. When you do this, respond in a way that’s positive and doesn’t make the person feel wrong for not being able to communicate in a way you understand. Your response should note exactly what they said, but you should say it in a way that you understand.

For example, you’re holding a toy that interests your child. You ask, “Would you like this toy?” Your child responds, “Toy, toy!” in a positive tone, pointing at the toy in your hand. By observing their behavior and the word they use, you can respond by saying, “Yes, I would like this toy,” before handing the toy to them.

What are the possible risks of not treating echolalia?

If a person has trouble communicating with the people around them, not treating this symptom can lead to:

• Anger, frustration and stress.
• Barriers to learning and education.
• Social isolation.
• Difficulty forming relationships.
• Anxiety and depression.

Can echolalia be prevented?

There’s no known way to entirely prevent echolalia. When your child is learning how to speak, exposing them to language is the best way to encourage clear communication. They can practice their language skills by repeating what they hear until they’re able to identify how to respond in a way that others understand.

When should echolalia be treated by a healthcare provider?

If your child continues echolalia after 3 years of age or learns and practices good communication and reverts back to echolalia, contact a healthcare provider. Adults who experience echolalia without a history of the symptom affecting them after age 3 should see a healthcare provider.